Endoscopic Spinal Surgery Aprajay Golash Consultant Neurosurgeon Royal Preston Hospital, UK.
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Transcript of Endoscopic Spinal Surgery Aprajay Golash Consultant Neurosurgeon Royal Preston Hospital, UK.
Endoscopic Spinal SurgeryEndoscopic Spinal Surgery
Aprajay GolashAprajay GolashConsultant NeurosurgeonConsultant Neurosurgeon
Royal Preston Hospital, UKRoyal Preston Hospital, UK
In this presentation I am trying to give a In this presentation I am trying to give a flavour of current spinal endoscopic flavour of current spinal endoscopic surgery and hopefully raise some interest surgery and hopefully raise some interest in this evolving field.in this evolving field.
I am making no attempt to give details of I am making no attempt to give details of any techinques but would be very happy to any techinques but would be very happy to be contacted on be contacted on [email protected]@lthtr.nhs.uk for details. for details.
Let’s see a case!Let’s see a case!
55yr, Female55yr, Female
Spastic paraparesis for 6 months, getting Spastic paraparesis for 6 months, getting worseworse
Options for accessOptions for access
ThoracotomyThoracotomy
Thoracoscopic (Video assisted)Thoracoscopic (Video assisted)
Mini- thoracotomyMini- thoracotomy
Posterior approachesPosterior approaches
Approach I choseApproach I chose
Thoracoscopic Discectomy- because it Thoracoscopic Discectomy- because it retains the advantages of thoracotomy for retains the advantages of thoracotomy for exposure but avoids high morbidityexposure but avoids high morbidity
Clinical outcomeClinical outcome
Good neurological recoveryGood neurological recovery
Less post operative painLess post operative pain
Early mobilisationEarly mobilisation
Intra operative CSF leakIntra operative CSF leak
Post Operative scansPost Operative scans
Endoscopic Spinal SurgeryEndoscopic Spinal Surgery
This is a developing and sometimes This is a developing and sometimes controversial field.controversial field.
While developing, patient safety must be While developing, patient safety must be maintained.maintained.
Outcome compared with “Gold standard” Outcome compared with “Gold standard” (there are no agreed gold standards for (there are no agreed gold standards for many conditions!)many conditions!)
Why endoscopic surgery?Why endoscopic surgery?
Less damage to normal structureLess damage to normal structure
Less blood lossLess blood loss
Quick recoveryQuick recovery
Less post operative painLess post operative pain
Easier approach in Obese patients!Easier approach in Obese patients!
May be done under local anaesthetic & May be done under local anaesthetic & sedation.sedation.
Cervical Endoscopic foraminotomyCervical Endoscopic foraminotomy
Percuteneous access with serial Percuteneous access with serial dialatationdialatation
Endoscopic magnified (but 2-D !) Endoscopic magnified (but 2-D !) visualisation.visualisation.
Minimal injury to musclesMinimal injury to muscles
Same results as open foraminotomy.Same results as open foraminotomy.
Cervical Endoscopic foraminotomyCervical Endoscopic foraminotomy
Indications- Indications- – Ideally for soft disc herniation but can be used Ideally for soft disc herniation but can be used
for “hard” disc.for “hard” disc.– Lateral recess or foraminal stenosisLateral recess or foraminal stenosis
Contra indications-Contra indications-– Large central disc or stenosisLarge central disc or stenosis– Instability or severe kyphosisInstability or severe kyphosis
Cervical Endoscopic foraminotomyCervical Endoscopic foraminotomy
Benefits- (over open procedure)Benefits- (over open procedure)– Minimal muscle traumaMinimal muscle trauma– Decreased hospital stayDecreased hospital stay
Disadvantages-Disadvantages-– Steep learning curveSteep learning curve– Separate approach required for bilateral Separate approach required for bilateral
procedureprocedure
Cervical Endoscopic discectomyCervical Endoscopic discectomy
Anterior percuteneous approach under x-Anterior percuteneous approach under x-ray controlray control
Mainly for soft discMainly for soft disc
C3-C7C3-C7
Better approached from contralaterl sideBetter approached from contralaterl side
May be done as day caseMay be done as day case
Avoids fusionAvoids fusion
Thoracoscopic spinal surgeryThoracoscopic spinal surgery
Herniated disc (even large calcified!)Herniated disc (even large calcified!)
Spinal fracturesSpinal fractures
Anterior release for scoliosisAnterior release for scoliosis
Biopsy for tumour or infectionBiopsy for tumour or infection
Endoscopic Lumbar surgeryEndoscopic Lumbar surgery
Approaches-Approaches-– Interlaminar Interlaminar – Posterolateral Posterolateral – Far lateral or extreme Far lateral or extreme – Anterior retroperitoneal Anterior retroperitoneal – Anterior trans peritoneal Anterior trans peritoneal
Endoscopic Lumbar surgeryEndoscopic Lumbar surgery
Indications-Indications-– Disc herniationDisc herniation– Degenerative disc diseaseDegenerative disc disease– Spinal stenosisSpinal stenosis– InfectionInfection– TumourTumour
Endoscopic Lumbar surgeryEndoscopic Lumbar surgery
Disadvantages-Disadvantages-– Difficult for migrated discDifficult for migrated disc– Long learning curveLong learning curve– Access to L5/S1 may be difficultAccess to L5/S1 may be difficult– Difficult with previous spinal surgeryDifficult with previous spinal surgery
Further DevelopmentsFurther Developments
Images Guided endoscopic spinal surgeryImages Guided endoscopic spinal surgery
3-D endoscopes3-D endoscopes
Intra dural endoscopic proceduresIntra dural endoscopic procedures
I was planning to put some video clips in this presentation but I found many good ones in You tube! Though this is not an alternative to visit some experienced surgeons but is good enough to get a flavour.
Caution!Caution!
Patient safety must be maintained while Patient safety must be maintained while learning curve is achieved.learning curve is achieved.
Patient selection is critical.Patient selection is critical.
No harm in using traditional approach if in No harm in using traditional approach if in any difficulty.any difficulty.